Cerebral Palsy

Dr Venkatesh CAssistant Professor of Pediatrics

Introduction

• Major cause of disability in children

• Incidence 1 in 500 births

• 70-80% are due to prenatal factors

• No known cure, Prevention is the key.

Antenatal Brain Growth

Postnatal Brain Growth

• Brain growth continues postnatally well into adolescence

• More than 90% Brain growth is complete by 2 years

• As age advances, myelination increases with pruning of synapses

Definition

• Disorder of movement and posture

• Non-progressive insult

• growing brain

• Dynamic manifestations

Aetiology

• Antenatal- Extreme prematurity, Multiple gestation, IEM, Genetic diseases, Brain malformation, Congenital infection, maternal toxemia, placental abnormalities, coagulopathy, Heamorrhage

• Birth- Low birth weight, MSL, Infection, trauma, Kernicterus

• Postnatal- infection, trauma, toxins

Pathology

Pathology

Pathology

Pathology

Types

• Spastic

• Dyskinetic

• Hypotonic/ataxic

• Mixed

Spastic CP

• 70-80% of CP

• Increased muscle tone- clasp knife type

• Increased reflexes, clonus, contractures

• Scissoring and toe walking

• Difficulty changing diapers

• Seizures & mental retardation

• Feeding difficulty

Types based on limb involvement

Hyperkinetic/athetoid

• 10-20% of CP

• Involuntary movements of hands, feet, arms, muscles of face/tongue

• Movements increased by stress, decreased by sleep

• Mental retardation

Hypotonic/ataxic

• Least common type

• Floppy infant

• Poor coordination

• Unsteady gait

• Difficulty in performing rapid movements

Mixed

• Combination of above

• Spastic and athetoid most common

• Hypotonic and athetoid

• Variable frequency of seizures, MR

Functional Classification

Early markers

• Persistent fisting/ cortical thumb

• Persistent primitive reflexes

• Irritability

• Delayed development

• Early hand preference

Asymmetric tonic neck reflex

Diagnosis

• Good history and physical examination

• Neuroimaging CT/MRI

• IU infection screen

• Metabolic & genetic testing

• Coagulation studies

• Screening for co-morbidity – vision, hearing, seizures

Treatment

• Multi-disciplinary approach

• Early stimulation

• Monitoring growth, nutrition

• Vision and hearing assessment

• Control of seizures

• Reduce spasticity and contractures

• Promote self care

Prognosis

• No head control by age 1- unlikely to walk

• Not sitting by 4 yrs- 99% will not walk

• Sits unsupported by 2 yrs- 100% will walk

Prevention

• Proper antenatal care and fetal monitoring

• Hypothermia

• Magnesium sulphate